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Between 10 and 20 million U.S. children have chronic health conditions (J.M. Perrin 1985). Most of these conditions are relatively mild and interfere little with normal activities, but approximately 1%-2% of children have conditions that have an impact on their daily lives (J.M. Perrin 1985). Chronic illnesses are illnesses of long duration or illnesses whose consequences are of long duration (J.M. Perrin 1985). More specifically, they are conditions that interfere with daily functioning for more than 3 months in a year, lead to hospitalization for more than 1 month in a year, or are expected to do either of these (J.M. Perrin 1985). Unlike adult illnesses, which are few in number and relatively common (e.g., arthritis, hypertension, and diabetes), there are many childhood chronic illnesses, and each of these is relatively rare.

Pediatric physical illnesses have become more prevalent in recent years. This rise is a result of increased life expectancy among children with chronic illnesses such as cystic fibrosis; improved survival rates among infants who are premature or of very low birth weight; and the emergence of new illnesses, such as AIDS, that can affect children (R.J.

Thompson and Gustafson 1996). Contributors to improved health and prognosis for these children include advances in the behavioral sciences surrounding the understanding and treatment of disruptive behavior, anxiety, and depressive disorders, as well as availability of manual-based treatments and medications such as the selective serotonin reuptake inhibitors (SSRIs). More than 90% of children with significant physical disorders are likely to survive into adulthood (R.J. Thompson and Gustafson 1996). This improved prognosis has fostered increasing interest in understanding the factors affecting adaptation and resiliency.

Childhood illnesses affect daily functioning via the direct medical effects of the illness, such as restrictions on a child's physical development and on abilities to engage in accustomed and expected activities. In addition, children may develop emotional and behavioral responses to the illness, including maladaptive coping strategies, which may last hours, days, months, or years. In addition, most chronic illnesses require intermittent pediatric services, such as for diagnosis, routine checkups, and medical crises. Physical illnesses can impinge on a child's health-related quality of life as a direct result of the disease state or as a result of a change in functional status or psychosocial functioning. These illnesses and their treatments may also cause physical pain and discomfort.

Much of the existing literature on the ways in which children and families respond to the demands of a chronic childhood illness has focused on evaluating coping responses. A coping response has been defined as an intentional physical or mental action, initiated in response to a perceived stressor, that is directed toward external circumstances or an internal state (Lazarus and Folkman 1984). In contrast, a stress response is a spontaneous emotional or behavioral reaction, and not a deliberate attempt to manage a situation. A coping goal is the objective or intent of a coping response, usually stress reduction or reduction of the negative impacts of a stressor (Lazarus and Folkman 1984).

In this chapter, we address the many factors that influence children's abilities to adapt to general medical conditions. The emphasis is on understanding how children's coping styles and developmental levels shape their emotional and behavioral responses to physical illness. Additional risk factors that have been linked to distress include history of medical procedures, child anxiety, parent anxiety, and parent interaction style. A thorough understanding of these factors can enable consultants to anticipate children's adjustment difficulties and to intervene effectively.

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